Inside Health

Telling Lessons of a Life Always Under Adaptation

By MARY DUENWALD

Published: February 3, 2004

With every step, Richard M. Cohen hitches to the left, bracing himself against his wooden cane. It is a rather long cane, as it has to support a man who is 6 feet 2. His uneven gait, caused by a feeble right leg, is only his most obvious symptom of multiple sclerosis.

There are many others, accumulated during 30 years of living with the disease. Mr. Cohen's right arm hangs motionless. Like his leg, it is not fully paralyzed, but it has lost enough feeling to be useless, as he puts it. Both limbs have lost their ability to function as the insulating layer of myelin that surrounds certain nerves in his brain and spinal column has disintegrated.

''Picture an old-fashioned switchboard,'' Mr. Cohen said. ''Insulation peels off the wires, and it short-circuits the system.''

By the same process, M.S. has so impaired his vision that he is legally blind. It has weakened his voice so that it sounds uneven in tone and pitch, like a very old man's. It has made sleeping difficult, leaving him constantly exhausted. And it has given rise to chronic pain in his right knee.

''Because my thigh is atrophied, I can't do what exercises need to be done to fix the knee,'' Mr. Cohen said. ''And I have disk problems, again, related to the way I've moved for years. One thing affects another, affects another.''

M.S. has not been his only problem. Two bouts of colon cancer in the past five years have left his intestines in disarray. And though he is currently cancer-free, he still lives with constant discomfort. ''Once they mess with your intestines, it's never the same,'' he said.

For all these ailments, he looks surprisingly ordinary: a clean-shaven 55-year-old man with soft brown hair and blue eyes.

Mr. Cohen spent his early adult years as a television producer, working, among other places, at the ''CBS Evening News'' with Walter Cronkite and Dan Rather.

Now, his days are taken up with the effort to cope with a life that is largely defined by illness. His many maladies are the basis of his new book, ''Blindsided: Lifting a Life Above Illness'' (HarperCollins). It is, as the second subtitle says, ''A Reluctant Memoir.'' It is also an extended treatise on the psychology of coping.

As he has done to some extent before, in columns written for Science Times, Mr. Cohen imparts in the book his insights into the mental challenge of chronic illness, insights that he believes may help others in similar predicaments.

''I regularly get calls from people who've been diagnosed with M.S.,'' he said last month, as he sat in an Upper West Side restaurant. ''I always tell them that the one thing that's in your control here is what's going on in your head. Don't panic. You've just signed up for a lifetime. First, learn about the illness. Second, start to think about who you are.''

The basic challenge, Mr. Cohen said, has been to find ways to live life as he wants to. The first strategy he found was denial.

''To me, denial is not seeing the possible consequences of illness as inevitability,'' he said. ''Denial bought me time to get my bearings, to learn about the illness.''

Yes, from the time of his diagnosis, in 1973, he had to admit to himself that he had M.S. That fact was made evident by his occasional stumbles as well as the sudden loss of sight in his right eye. But he did not plan his life around it.

Instead, after finishing graduate school at Columbia University, he took a producing job at CBS News and for the next few years, traveled to the world's war zones, working in the thick of battles in Beirut and El Salvador. The symptoms of M.S. came on over the years, so he was able to manage the work. Still, his impaired vision intensified its dangers.

It was, he writes, a form of ''healthy self-delusion.''

''I believe in that,'' he said. ''That's how you keep going. When you have this kind of problem, you've got to push and push and push.''

In the early years, Mr. Cohen also found that silence helped. When he applied at CBS, he kept his illness to himself. He even faked his way through the required company physical. In later years, one of his bosses admitted that Mr. Cohen would not have been hired had he disclosed his disease.

In his personal life, he said, ''I went from obsessive secrecy -- I mean I told no one -- to being less secretive about it. But it was still nothing I really talked about.''

Another strategy Mr. Cohen has used to advantage, though sometimes regretfully, is anger. He calls it ''the polar opposite of denial,'' when frustration overflows, he said.

For example, there was the day when no one was home to help him unbutton a shirt he wanted to take off. With no assistance, buttoning or unbuttoning a dress shirt can take him 15 to 20 minutes. Cuffs and the top button are impossible for him to manage alone. ''I just tore it from my back,'' he said. With a smile that seemed wistful, he added, ''It was a nice shirt.''

''It was really stupid,'' he added. ''I don't do that that much. But occasionally, for better or for worse, I need to just let the steam off.''

At times, his anger has been directed at doctors: a succession of neurologists who have been unable to fully explain or provide treatment for his symptoms.

A few times a week, Mr. Cohen injects himself with medicines intended to retard the progression of M.S. But these do nothing to relieve the symptoms he already has.

''You know what?'' he said. ''I will die never knowing whether these shots did anything for me.''